There are a number of ways that I could approach this perennial issue that rouses strong and often polarising opinions. I have a graduate diploma in bioethics, and a masters in health ethics, so I’m well versed and better qualified than many to take a relatively objective stance and present a robust, solidly-constructed argument based on virtue ethics, Beauchamp and Childress’s Principles, casuist philosophy, or even a Hippocratic perspective. I could present an argument from self, about what I would want, and invoke Mills, who argued that there are limits to the reach of the state over the individual. Or I could, as SA nurse Sandy Bradley has, speak from a professionally dispassionate perspective, with citations and an academic tone.

These are all valid, useful ways to discuss assisted suicide/voluntary euthanasia, and reading these kinds of pieces have informed my position. But what has most strongly strengthened my commitment to the legalisation of assisted suicide isn’t theory, or research, or philosophical argument. It’s the patients I’ve cared for, and those for whom my care was woefully inadequate. The patients whose memories still bring tears to my eyes, a lump to my throat, and a sensory reminder of the frustrated impotence I felt when “everything we can do” wasn’t close to being enough.

I have seen people in kinds of distress I wish I never knew existed, experiencing so much pain it’s been hard to believe it didn’t kill them. The very first person I saw die vomited and retched until the moment she died, despite high doses of antiemetics. I’ve helped a colleague turn a patient whose limbs were so swollen with excess fluid that they wept, constantly, a physical grief reflecting his unending moans. I cared for a frequent flier patient, who I had come to know well over the course of almost a decade, who crawled up the ward corridor crying for pain relief I was forbidden to give her because the doses that would lower her pain would also kill her – she died less than a week later, still in pain. I had to tell the wife of another familiar and dear patient that I couldn’t help him die sooner, though it was what I wanted to be able to do even before she dropped to her knees before me, and begged.

Over a decade ago I heard Roger Magnusson talk about his doctoral research that, in part, described, the kinds of deaths that occurred in the absence of formalized, legalized assistance, and I was horrified by the lack of screening, the lack of dignity, and the effects on everyone involved. Earlier this year, at the ANMF (Vic branch)’s annual delegates conference, I heard Andrew Denton speak about watching his beloved father, Kit, die over an eternity of three days. It reinforced my belief that the time has well and truly come for Australia to join those countries and states that offer their dying and suffering populations another choice at the end of life, if the interventions currently available aren’t enough.

There have been dozens of Bills brought in front of parliaments across the country, with varying degrees of traction, but none with success – in part because there were inadequate safeguards to protect our most vulnerable, but mostly because opposition from organized religion (such as the Australian Christian Lobby) has been better mobilized, and louder; their position may be the minority one, going by every poll on assisted dying, but their voices are disproportionately heard, and that’s neither right nor fair.

I understand concerns about both coercion of people who are influenced by unethical family members, and the fear of a slippery slope to wholesale, state-sanctioned murder; I do not agree either or both are reason to prevent those who are dying, suffering, and beyond the reach of palliative care from having the option of a faster, kinder route to the death their condition makes inevitable. Instead any legislation should be informed by these reasonable concerns, by including rigorous safeguards to protect those at risk of underhand manipulation. I will write at some future point about how the ‘euthanasia’ committed by Nazi Germany in the 1930’s and 1940’s was not only qualitatively unrelated, but also the result of very different motivation; for now, suffice it to say that this is neither a likely nor plausible end point when we start by looking at compassionate, patient-centred, voluntary additional options for competent people who are terminally ill.

I’ve just read a post on the FB page of the same name as this post – It’s okay, not to be okay post stories and support for and about Astralian men battling (and too often the ultimate victims of) depression.

The story I read was exceptionally well written by the partner of a man whose depression overwhelmed him. Nicole’s pain was heightened by the fact that the notification of his death, by police accompanied by her mum, occurred hours after the birth of their baby.

For me, the biggest takeaway message was a regret expressed to Nicole by one of Pat’s friends:

None of Pat’s friends were aware he’s suffered from depression…

One of his mates told me how much he wish[ed] he knew Pat had suffered, as [he] was a sufferer too and wished they could have talked about it.

This is the silence that makes so many people with depression, particularly men, think they’re alone – not Pat’s mate, but society’s silence. And I understand it – for 29 years I told nobody of my episodic, far less malignant, depression, which is a long overdue story for another post.

Though saddened and troubled by this account, what stirred me to write this post were the comments from people who, despite Nicole’s clear descriptions of Pat’s pain, still saw his death as “weak,” “selfish,” “a coward’s act,” and not something anyone would do if they really loved those they leave behind.

MRI and PET scan imaging shows that major depression alters the way our brains work – it’s not something you can overcome through strength of will, fortitude, determination, or the live and support of those around you, and more than these would stop asthma or diabetes.

This outcome may have been different if Pat had help (antidepressants, therapy, inpatient care in crisis, even much maligned but sometimes invaluable ECT), but mental ill health is so strongly stigmatised, and this ‘snap out of it’ mentality so prevalent, that he fought alone.

For many people with major depression, the utter bleakness and pain of living is overwhelming. They may think their existence is a burden on those they love, that everyone would be better off without them. They’re wrong, but that feels so true they believe it. Surviving every day takes more work and courage for some people than many of these commenters will ever need to draw on.

For people who still can’t or don’t get that, know this – first, you are luckier than you realise. Second, if you don’t understand, shut up. Your uninformed opinions about depression are not just unhelpful, they’re actively damaging to those surviving with depression, and those left behind when the disease was too much.

Nurses are not alone in having positions where our work includes the potential for misuse of power over vulnerable people. As Australians have been appalled to learn in the last week, as footage of barbaric treatment of detained children was broadcast on Four Corners, there are professional cultures where egregious mistreatment (and that is an unquestionably mild categorisation) appears to not only be accepted but almost expected.

Nursing is not immune to that – several years ago I wrote about the horrifying treatment of patients at Mid Staffordshire in the UK, the contributing institutional factors, and the injustice of focusing on clinicians alone instead of the managers whose policies not only facilitated but almost demanded it.

It’s reasonable to expect that, at a bare minimum, those in our care are treated humanely and with respect. As I’ve commented several times on social media since the ABC broadcast, excusing corrections officers’ actions because of juvenile detainees’ behaviour misses the mark. I have been spat at, sworn at, threatened, slapped, pinched, bruised, groped, scratched, punched, and had projectiles from faeces to metal bed pans thrown at me; my colleagues have been sexually assaulted, knocked unconscious, partially scalped, contracted infectious diseases after being spat on, had bones fractured, and needed breast reconstruction after biting. Not only do we not retaliate by dropping patients naked and leaving them, restrained and alone, to do so would justifiably be condemned, by our profession and the public.

We are, however, human. We carry with us to work the same stressors everyone else does – relationship woes, family worries, financial concerns, inadequate sleep, colds that are enough to cause misery but not enough to warrant time off work… When work frustrations are added to that, sometimes something has to give.

I love what I do. I get to make positive differences to people’s lives every day: my colleague said, through education and support; family members, with explanation and reassurance; most of all my patients, through skilled, compassionate, experienced nursing care. After returning to the bedside after over a year of illness, my commitment to providing that care is even stronger.

I am proud of few things – I am privileged that most of my positive attributes come without work, so taking pride in something I have by good fortune would be ridiculous. I am, however, proud of managing my temper (which was once significant), and my still-evolving capacity to step back rather than engage and escalate conflict. These are not qualities that came effortlessly, for all their necessity in my position.

Despite one’s very best efforts at calm, professional, therapeutic distance, sometimes someone manage to find your last nerve and play it like a virtuoso. And I recently had a shift that was dominated by a patient for whom I could do no good, as I was repeatedly told, but who nonetheless called for me multiple times each hour, only to react with anger and disparagement despite my genuine best efforts to help.

It is fortunate that my other patients were stable, needing few interventions; I was certainly unable to assist and support my colleagues as much as I’d have liked.

I know my patient was scared, distressed, anxious, panicked on occasion, enormously fatigued, sleep deprived, and angry. I also know that we are often safe targets – our patients know we won’t abandon them, or retaliate. I certainly hope they know that.

And, despite my experience, my empathy, my knowledge, and decades of honing professional distance, I became frustrated – by not being able to meet my patient’s needs, by their expectation that I should know what they wanted without asking, by my every suggestion being shot down, by going over the same ground with repeated futility, by hours of belittlement.

I didn’t express any of my frustration to my patient – though I took a slow, deep breath before responding to each call, every interaction was polite, warmly professional, as long as my patient needed, and I responded in under a minute on every singly occasion.

The reason I was able to maintain this for my whole shift was because I vented my frustration to my colleagues. A little hyperbole, some fantasy, and I was able to optimistically smile the next time I walked through the patient’s doorway.

All of this has been preamble to the point of this post. I also wrote a Facebook entry where I described my venting. There, as here, as always, I omitted identifying details. I made it clear that the issue was not so much my patient as my frustration. And I wrote about how this informal debriefing allowed me to work effectively, to provide professional care, to put my patient’s needs first.

And I was reminded today that none of those aspects matter, because my post could have been enough to jeopardise my registration. The days of acknowledging the emotion labour of dealing with ‘difficult’ patients have gone – when text, absent tone, can make jest indistinguishable from the corrosive, toxic culture revealed last week, staying silent is the safest option.

Every week nurses and midwives attend disciplinaries, recieve warnings, and face employment and registration consequences of social media activity. Oftentimes this is completely warranted, because of confidentiality breeches, employment conditions (don’t take sick leave then tweet about being at a music festival!), and the like. Sometimes it may seem like an overreach. Either way, determination isn’t made by those who know us and our intent – it’s made by people whose job is to safeguard the public, and who understandably err on the side of caution.

I am no social media neophyte. As a union rep I have a better idea than most how inappropriate social media posts comprise a significant, and growing, number of disciplinary procedures. And even as I wrote my post I wondered how wise it was, even adorned with caveats and clarifying notes.

So, for myself and for any health professional who’s made it this far, a reminder: before posting anything remotely work- or profession-related, think twice. And if even the smallest part of you has any doubt, hold back – you can always write it later, you may not be able to retract it.